Behavior Support Plan Sonoma County SELPA Jun-08

Behavior Intervention Plan---Sonoma County SELPA

For Behavior Interfering with Student’s Learning or the Learning of Peers

This BIP attaches to: IEP (date): / 504 plan (date): / Team meeting (date):
Current Primary Placement: Gen Ed / Special Ed / 504 Plan

This is an initial BIP This BIP is a revision of the BIP dated

Student Name: / Today’s Date: / Plan Review Date:
School: / DOB: / Teacher:
Grade: / Case Mgr: / Psychologist:
Assistant: / Behavior Specialist:

1. Student Strengths:

2. Target Behavior: Description of problem behavior(s) – from mild to more intense

3. Frequency, and/or Intensity, and/or Duration of Target behavior:

4. Antecedents & Prevention:

Triggers within curriculum, instruction, environment and/or intra/interpersonal situations in which behaviors are likely to occur: / Changes needed by staff to remove likelihood of behavior occurring:
·

5. Function of Behavior: ( i.e. to get or obtain, to avoid or escape, and/or sensory regulation)

6. Replacement Behaviors: Describe & define an acceptable alternate behavior that meets the same function of the target behavior

7. Instructional Strategies to teach the Replacement Behaviors/Skills to the student:

8. Reinforcement Procedures to use for establishing, maintaining and generalizing the replacement behaviors:

9. Reactive Strategies to use when the target behavior occurs - from mild to more intense:

· Prompt the replacement behavior

10. Communication: How, to whom, (all participants) and at what frequency, will the progress/data be reported?

Method: Between: Frequency:

11. Data Collection following Implementation of this Plan:

· Target Behavior (how often, by whom)

· Replacement Behavior (how often, by whom)

12. Criteria for Success: (How will plan be faded? How will you know when the plan is successful?)

Participants in the Plan Development:

Student ______Administrator ______

Parent/Guardian ______Parent/Guardian ______

Educator & Title ______Educator & Title ______

Occupational Therapist ______Behavior Specialist ______

Speech Therapist ______Other ______

Psychologist ______Other ______

· Reminder for students with IEPs: Behavior Goal(s) need to be added to SELPA form #4 (goal page)

Goal # : By (date), instead of (problem behavior), to achieve (function), (student) will do (replacement behavior), under what conditions, at what level of proficiency, as measured by whom and by what means

Revised 9/11/13